Guidelines steps of tx.

Question 1

According to BSP 2017 guidelines, what is step 1 tx for periodontal disease?

Answer 1

• Explain disease, risk factors, tx (including risks and benefits of tx/ NO tx.)
• Explain importance OH, encouraging behaviour change
• Tailored OHI
• Reduce risk factors - smoking cessation, diabetic control management, plaque retentive factors
• MPBS
• Supragingival pmpr
• Recall appointment

Question 2

According to BSP, what should happen if a patient is non-engaging following step 1 treatment?

Answer 2

Back to step 1 and repeat

Question 3

According to BSP guidelines, what should happen is ENGAGING following step 1 treatment?

Answer 3

Move to step 2 treatment

Question 4

Definition of an engaging patient in perio tx.?

Answer 4

Favourable improvement in OH - >50% improvement in plaque and marginal bleeding scores
OR
Plaque levels <20% & bleeding levels <30%
OR
Patient has met targets outlined in their personal self-care plan as determined by their healthcare practitioner

Question 5

Definition of non-engaging patient in perio tx.?

Answer 5

Insufficient improvement in OH - <50% improvement in plaque and marginal bleeding scores
OR
Plaque levels >20% & bleeding levels >30%

Question 6

According to BSP guidelines, what is STEP 2 perio tx.?

Answer 6

Re-inforce OH, risk factor control, behaviour change
Subgingival instrumentation (RSD/ subgingival pmpr)
Can be hand or ultrasonic instrumentation alone or combined

Question 7

According to BSP guidelines what is the re-evaluation wait time following STEP 2 perio tx?

Answer 7

Re-evaluate after 3 months

Question 8

According to BSP guidelines, if patient’s perio is UNSTABLE what should be carried out?

Answer 8

STEP 3 - managing non-responding sites
- Reinforce OH, risk factor control, behaviour change
- Moderate (4-5mm) residual pockets - re-perform subgingival instrumentation
- Deep residual pocketing (>6mm) - consider alternative causes

Question 9

According to BSP guidelines what should be done if deep residual pockets (>6mm) remain?

Answer 9

Either re-instrument
OR
Consider referral for pocket management or access/ regenerative surgery

Question 10

According to BSP guidelines, what is STEP 4 management in perio tx.?

Answer 10

Supportive periodontal care strongly recommended
Reinforce OH, risk factor control, behaviour change
Regular targeted pmpr as required to limit tooth loss
Consider evidence based toothpaste/ mouthwash to control gingival inflammation

Question 11

According to BSP guidelines, what is the maintenance recall for STEP 4 treatment?

Answer 11

3-12 months - individually tailored intervals

Question 12

According to BSP guidelines when should a 6PPC be carried out?

Answer 12

Code 3 - post treatment

Code 4 - before and after treatment

Question 13

SDCEP
What is the tx. for endo-perio lesion?

Answer 13

Carry out endo tx
Recommend analgesia
DO NOT prescribe antibiotics unless there are signs of systemic involvement
Recommend use of 0.2% CHX until acute symptoms subside
Following acute management, review within 10 days and carry out supra/sub gingival pmpr.

Question 14

What are the aims of periodontal treatment?

Answer 14

Control patient’s symptoms
Reduce inflammation
Provide advice on risk factor control to reduce the risk of ongoing future disease
Stabilise disease
Support patient after treatment is complete to either limit further tissue loss or prevent recurrence of disease

Question 15

What are the ideal treatment outcomes for HPT/ perio treatment according to SDCEP?

Answer 15

Plaque scores <15%
Bleeding scores <10%
Probing depths <4mm

Question 16

What are the keystone pathogens for periodontitis?

Answer 16

P. gingivalis
T. forsythia
T. denticola

Question 17

What type of bacteria is P. gingivalis and describe some of its virulence factors?

Answer 17

Gram negative, non-motile, strict anaerobe

Fimbrillar adhesins - help invade membrane vesicles host cells by binding to cells.
Contains lipopolysaccharide which stimulates production of cytokines - increase inflammatory response.

Question 18

What risks/ un-desirable side effects must you make patient aware of when consenting to periodontal treatment?

Answer 18

Appearance of black triangles may appear between teeth
Gum recession
Temporary increase in mobility of teeth which should get better after a few weeks
Short-term sensitivity following cleaning from your dentist
Increased susceptibility to root decay
May notice initial increase in bleeding when brushing but this should decrease over time

Question 19

What are some benefits of perio treatment you can tell your patient?

Answer 19

Can keep teeth for longer
Gums not bleeding and will be less painful
Mouth will feel fresher
May improve your diabetes (if applicable)

Question 20

In a perio chart what results would show teeth with the worst prognosis?

Answer 20

LOA - less supporting structures for the tooth, increased risk of tooth loss
Mobility - reduced bone support increased risk of tooth loss
Furcation involvement - more difficult to keep clean, increased risk of caries

Question 21

What are some local causes of periodontal disease?

Answer 21

Calculus build-up
Malpositioned teeth
Restoration overhangs
Partial dentures